Encopresis: Its potentiation, evaluation, and alleviation

Abstract

Encopresis offers an interesting model for behavioral pediatrics. In its pathophysiology, diverse forces intermingle in varying degrees at predictable life stages. Among these are endogenous or congenital predispositions, the effects of early experience, the impacts of nurturance, possible iatrogenic effects, developmental and maturational phenomena, issues of training and discipline, the impacts of school. The management of encopresis requires an eclectic approach which combines the role of the physician as a diagnostic formulator, a demystifier and educator, a pharmacotherapist, a counselor, a strong child advocate and co-conspirator, and a triage officer for further referral when needed. Like other disorders of function in children, encopresis can test and strain the doctor-patient interface as severely as it threatens parent-child interactions. The challenge is in sustaining the helping relationship, persevering, uncovering strengths in a struggling child and family, and ultimately making good on the implied promise not to give up or abandon the case until the problem that they came in for gets fixed.